Charcoal-radionuclide agents for measurement of gastrointestinal transit

ABSTRACT

A unit dosage form is provided which comprises an effective amount of a radioisotope adsorbed onto activated charcoal, and which is preferably enterically coated. The unit dosage form is useful for the measurement of intestinal transit.

GOVERNMENT SUPPORT

This invention was developed in part with the assistance of NationalInstitutes of Health Grant No. RR00585. The Government has certainrights in the invention.

CROSS REFERENCE TO RELATED APPLICATION

This application is a divisional of application Ser. No. 08/698,209,filed Aug. 14, 1996, now issued as U.S. Pat. No. 5,827,497, which isincorporated herein by reference.

BACKGROUND OF THE INVENTION

Disorders of colonic motility are thought to underlie several commonclinical problems, yet of all segments of the human gut, motility of thelarge bowel is least understood. Whereas definitions of normal motilityin the esophagus, stomach, and small bowel have allowed regionalpathophysiologies to be recognized, normal patterns of motility in thecolon are highly variable and poorly defined. Thus, even though severaldistinctive colonic motor patterns have been described in disease, theirrelationships with symptoms are unclear.

Measurement of colonic transit is a useful clinical and researchtechnique to evaluate patients with suspected motility disorders of thecolon. There are several methods by which colonic transit can bequantified in humans. These approaches include (1) techniques thatassess mouth to anus transit, which, however, provide no information onsegmental colonic transit; (2) cinefluorography, which is helpful butseverely limited by the level of radiation required; (3) the ingestionof radiopaque markers of different shapes with a single or sequentialabdominal radiographs; (4) radioisotopic methods, by which liquidradiolabels have been infused into the cecum or splenic fixture. Otherradioisotopic methods that have been used include radiolabeled solidmarkers administered orally either as free particles or enclosed withina capsule. For example, ¹³¹ I-labeled cellulose fiber has been used inradioscintigraphic studies of gastric and small bowel transit. See, forexample, M. Camilleri et al., Am. J. Physiol., 257, G284 (1989).However, this material is difficult to synthesize, employs a β-radiationsource and may be thermally altered when the food carrier is cooked.

These radiological and radioisotopic methods have provided quantitativedata on regional colon transit. However, none of these methods are idealfor physiological studies for a number of reasons: some involveintubation and/or preparation of the colon; some evaluate liquid transitin the colon, whereas the movement of particulate matter is probablymore relevant. Others do not identify the precise starting point fromwhich colonic transit can be assessed. In particular, the radiopaquemarker method, although widely available, inexpensive, and reproducible,requires that the patient is available for four or, more commonly, sevendays in order to evaluate the transit profile in the colon by means oftwo radiographs. Metcalf et al., Gastroenterology, 92:40 (1987);Stivland et al., Gastroenterology, 101:107 (1991).

The need to have a test with a faster completion time led us to developa radioscintigraphic approach that has since been simplified andutilized clinically. Proano et al., Am. J. Physiol., 258:G856 (1990).;Camilleri et al., Gastroenterology, 103:3 (1992); Charles et al., MayoClin. Proc., 70:113 (1995). The method involves radiolabeling ionexchange resin pellets with radioisotopes such as ⁹⁹ Tc or ¹¹¹ In anddelivering them to the colon in a delayed-release, polymer-coatedcapsule that dissolves in the alkaline pH of the terminal ileum.However, although initial research studies have shown that theseradiolabeled resin pellets are efficacious in measuring colonic transit,there are several constraints on their widespread use.

Specifically, since the resin pellets are not listed in the UnitedStates Pharmacopoeia (USP) and are considered to be a new drug moiety,an investigational new drug (IND) application must be filed with theFederal Drug Administration (FDA) prior to their use. In a clinicalvenue, the IND application and the accompanying requirement ofnotification of every new project and adverse effect is burdensome andexpensive and reduces considerably the cost efficacy of the study.Moreover, and also as a result of the fact that the resin pellets areclassified as an investigational drug, there are problems withreimbursement from third-party payers for the clinical use of colonictransit tests.

Therefore, an improved marker for the measurement of colonic transitthat overcomes all of the aforementioned drawbacks is needed as such amarker would be extremely useful for diagnostic and physiologicalstudies in health and disease.

SUMMARY OF THE INVENTION

The present invention provides a unit dosage form which is effective tomeasure gastrointestinal transit in human subjects. The unit dosage formcomprises an effective amount of a radioisotope adsorbed on activatedcharcoal. It is preferred that the radioisotope be one that is widelyavailable and that binds readily to activated charcoal by physicalprocesses such as adsorption. Most preferably, the radioisotope isselected from the group consisting of ^(99m) Tc, ¹¹¹ In, ²⁰¹ Tl, and ⁶⁷Ga. Preferably, the unit dosage form, or the charcoal-radioisotopeparticles within the dosage form, is enterically coated. These unitdosage forms are effective to measure colonic transit.

The present invention also comprises a method of measuringgastrointestinal or colonic motility, said method comprising (a)administering to a subject a unit dosage form comprising an effectiveamount of a radioisotope adsorbed on activated charcoal and (b)employing scintigraphy to measure the gastrointestinal or colonictransit of said radioisotope. It is preferred that the subject be amammal, and more preferably, that the subject is a human. It is furtherpreferred that the radioisotope be selected from the group consisting of^(99m) Tc, ¹¹¹ In, ²⁰¹ Tl, and ⁶⁷ Ga. As used herein, an "effectiveamount" is that amount of radionuclide-charcoal sufficient to allow agastrointestinal or colonic transit profile to be obtained byscintigraphy.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 depicts the anterior and posterior scintiscans of ^(99m)Tc-activated charcoal and ¹¹¹ In-resin pellets which illustrates thedistribution of radioisotope in the colon at 24 hours after ingestion ofa delayed-release capsule containing both markers in a healthyvolunteer's colon.

FIG. 2 is a graphical depiction of a time-activity curve of ¹¹¹In-Amberlite® pellets and ^(99m) Tc-activated charcoal in the colon over32 hours after ingestion. Geometric center 0 represents the ileocolonicjunction, 1 represents the hepatic flexure, 2 represents the splenicflexure, 3 represents the end of the descending colon, 4 represents theend of the rectum, and 5 is the stool.

FIG. 3 illustrates the difference in geometric center of ^(99m)Tc-activated charcoal and ¹¹¹ In-pellets at scan times for eachindividual identified by a different symbol.

FIG. 4 illustrates the variance of difference in geometric center of^(99m) Tc-activated charcoal and ¹¹¹ In-pellets at scan times in 10healthy participants.

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides unit dosage forms comprising an effectiveamount of radionuclide-bound activated charcoal that are not entericallycoated, i.e., that release the charcoal in the stomach. Thus, the dosageforms of the present invention can be used to measure motor function ofthe entire gastrointestinal (g.i.) tract and particularly the colon,which is useful in evaluating patients with abdominal complaints such asirritable bowel, constipation and diarrhea as well as unexplainednausea, vomiting, early satiety, and abdominal pain. These symptomcomplexes constitute more than 50% of all patients referred togastroenterologists. There currently is no approved agent/test which canreplicate such a noninvasive test of gut motility.

Applicants have made the surprising discovery that the unit dosage formof the present invention is as effective as the currently usedresin-based marker for measuring colonic motility while providing anincreased ease of use. A particular advantage of the invention is that,because the materials used to manufacture the unit dosage forms of thepresent invention are all approved by the FDA, there is no need to applyfor an IND for the clinical use of the unit dosage form of the presentinvention.

A. Activated charcoal

Activated charcoal or "activated carbon" is a fine, odorless, tasteless,porous, black powder of about 0.1-0.2 mm particles (pores 2 5 nm) thatis free of grittiness. Preferably, 100 mesh (0.15 mm) activated charcoalis used. It is prepared from vegetable matter by carbonization processesintended to confer a high adsorbing power. It is practically insolublein all usual solvents and is relatively nontoxic in single, 50-100 gadministrations at a dilution of 20 g in 240 ml water. It can adsorb awide range of plant and inorganic poisons and many drugs. It rarelycauses vomiting when administered orally. Activated charcoal is approvedfor use as a medicinal by the FDA, fulfills the USP Standards, and caneffectively associate with different radionuclides. See H. W. Davidsonet al., Manufactured Carbon (Pergamon Press, N.Y., 1968); Smisek et al.,Active Carbon (Elsevier Pub. Co., Amsterdam, 1970); Merck 1815 (11th ed.1989).

B. Radioisotopes

Any radioactive element that is approved for administration to humanscan be used as the radioisotope in the present invention. Suitable ionsinclude the following: Antimony-124, Antimony-125, Arsenic-74,Barium-103, Barium-140, Beryllium-7, Bismuth-206, Bismuth-207,Cadmium-109, Cadmium-115m, Calcium-45, Cerium-139, Cerium-141,Cerium-144, Cesium-137, Chromium-51, Cobalt-56, Cobalt-57, Cobalt-58,Cobalt-60, Cobalt-64, Erbium-169, Europium-152, Gadolinium-153,Gallium-67, Gold-195, Gold-199, Hafnium-175, Hafnium-175-181,Indium-111, Iridium-192, Iron-55, Iron-59, Krypton-85, Lead-210,Manganese-54, Mercury-197, Mercury-203, Molybdenum-99, Neodymium-147,Neptunium-237, Nickel-63, Niobium-95, Osmium-185, 191, Palladium-103,Platinum-195m, Praseodymium-143, Promethium-147, Protactinium-233,Radium-226, Rhenium-186, Rubidium-86, Ruthenium-103, Ruthenium-106,Scandium-44, Scandium-46, Selenium-75, Silver-100m, Silver-111,Sodium-22, Strontium-85, Strontium-89, Strontium-90, Sulfur-35,Tantalum-182, Technetium-99m, Tellurium-125, Tellurium-132,Thallium-170, Thallium-201, Thallium-204, Thorium-228, Thorium-232,Tin-113, Titanium-44, Tungsten-185, Vanadium-48, Vanadium-49,Ytterbium-169, Yttrium-88, Yttrium-90, Yttrium-91, Zinc-65, andZirconium-95. Preferably, the radioisotope used in the present inventionis metastable technetium-99m (^(99m) Tc), thallium 201, gallium 67 orindium 111. A mixture of one or more radionuclide may be used in somecases. As used herein, the term "radionuclide" or "radioisotope" alsoincludes any organic chelating agent that may be associated therewith.

1. ^(99m) Tc

Metastable technetium (^(99m) Tc) is the principle radioisotope used inclinical diagnostic nuclear medicine and is reactor-produced.Specifically, the form of technetium 99m utilized in the presentinvention is the diethylenetriaminepentaacetic acid chelate oftechnetium 99m, i.e., ^(99m) Tc-DTPA.

^(99m) Tc-DTPA is prepared by the addition of 2-8 ml sterile ^(99m)Tc-pertechnetate sodium saline solution (Amersham Healthcare,Medi-Physics, Inc., Arlington Heights, Ill.) to a DTPA reaction vialcontaining 5 mg pentetate pentasodium and 0.17 mg (min.) stannouschloride as a reducing agent for ^(99m) Tc-pertechnetate. If sterileconditions are maintained, no further purification is required. DTPAreaction vial (DTPA [chelate] multidose kit) is commercially availablefrom a variety of providers, including Amersham Healthcare,Medi-Physics, Inc., Arlington Heights, Ill.

Although not a true chelate, ^(99m) Tc-DTPA does not tend to concentratein any organ as is the case with ^(99m) Tc-pertechnetate, which followsthe pathway of iodide. ^(99m) Tc-DTPA is uniformly distributedthroughout the extracellular space and is rapidly cleared by the kidneyswithout retention. The compound has previously been used for brain andkidney visualization and for vascular dynamic studies.

2. ¹¹¹ In

Indium-111 normally exists in aqueous solution in the +3 valence statesince indium compounds of lower valencies are unstable. Indium (+3) ionsare colorless and resemble aluminum (+3) ions in many ways. Theradioisotope is prepared by bombarding a cadmium target with 15 MeVdeuterons to produce ¹¹¹ In. ¹¹¹ In is then etched from the target withHCl, carrier Fe³⁺ is added and the ¹¹¹ In is precipitated, along withFe(OH)₃, by adding NH₄ OH. The precipitate is separated, dissolved inHCl, and the ferric iron removed by extraction with isopropyl ether. ¹¹¹In is commercially available from Mallinkrodt (St. Louis, Mo.) andAmersham/Medi-Physics (Arlington Hts, Ill.).

¹¹¹ In has been used to tag a variety of compounds, including ¹¹¹In-transferrin, which has been used for a replacement for ¹³¹ I-HSA, ¹¹¹In-EDTA and ¹¹¹ In-DTPA, useful for cistemography and ¹¹¹ In-bleomycin,which has been used for tumor localization.

¹¹¹ In-DTPA is prepared by adding ¹¹¹ InCl₃ (550-600 μCi) injectablesolution to 1 mg Na-DTPA in a test tube vortexing the mixture for 2minutes. Sterile 12.6% anticoagulant citrate dextrose (ACD)/salinesolution (6 ml) is added, vortexed and the pH adjusted to 6.5 with 1.0 NNaOH.

3. ²⁰¹ Tl

²⁰¹ Tl is prepared by bombarding thallium with protons to produce ²⁰¹Pb. The radioactive lead is complexed and the undesirable thalliumtarget material is removed by ion exchange. The lead radioisotopes arethen affixed to another column from which ²⁰¹ Tl is eluted following itsformation by decay of ²⁰¹ Pb. ²⁰¹ Tl is commercially available fromMallinkrodt (St. Louis, Mo.).

²⁰¹ Tl is used in myocardial imaging for diagnosis and localization ofmyocardial ischemia and infarction. See Angello et al. (U.S. Pat. No.4,824,660). It is an adjunct to angiography. Thallium mimics potassiumions and is taken up by the cells of the heart; a decrease in thevitality of the cells is indicated by decreased ²⁰¹ Tl uptake. It hasbeen reported that ²⁰¹ Tl is also useful for thyroid imaging, inparticular for the detection of marked goiter and thyroid carcinoma.

4. ⁶⁷ Ga

Gallium 67 is produced by proton irradiation of ⁶⁷ Zn enriched ZnO₂. ⁶⁶Ga and ⁶⁵ Ga are formed at the same time, but decay rapidly due to theirrelatively short half-lives. The resulting ⁶⁷ Ga is essentiallycarrier-free. The expiration date of the product is limited by the 78hour half life of ⁶⁷ Ga. ⁶⁷ Ga is available commercially from DuPont(Billerica, Mass.) and Amersham/Medi-Physics.

⁶⁷ Ga has been used to diagnose lesions of the lung, breast, maxillarysinuses and liver by using scanning and organ-imaging techniques. Inaddition, ⁶⁷ Ga is useful for placental localization and for theidentification of certain inflammatory conditions such as pancreatitisor inflammatory bowel disease.

C. Unit Dosage Forms

The present unit dosage forms are preferably prepared usingpharmaceutically acceptable carriers adapted for oral administration insolid ingestible dosage forms, or dispersed in a nontoxic liquidcarrier, such as an aqueous vehicle, to the desired concentration, andat a pH at which the enteric coating, if any, is stable.

The unit dosage form of the present invention intended to measurecolonic transit is preferably enterically coated so that the radioactivemarker adsorbed on the activated charcoal (RMAAC) is released from theunit dosage form in the lower intestinal tract, e.g., in the terminalportion of the ileum and in the colon of the patient. As noted above,another embodiment of the invention provides a unit dosage form of theRMAAC for measurement of gut motility that is not enterically coated. Inthe case of enterically coated dosages, microparticles of the RMAAC maybe individually coated and delivered in a suspension in a liquid carrier(vehicle), or may be encapsulated as an enterically coated powder orsuspension in a liquid or semi-solid vehicle in hard or soft gelatincapsules. Alternatively, the RMAAC may be encapsulated as a solid orsuspension in a hard or soft gelatin capsule that is itself entericallycoated. The RMAAC can also be combined with adjuvants employed in solidunit dosage forms, such as fillers and binders, compressed into shaped,solid dosage forms such as pills or tablets, and the pills or tabletstreated so as to apply an enteric coating of suitable thickness thereto.

Enteric coatings are those which remain intact in the stomach, but willdissolve and release the contents of the dosage form once it reaches thesmall intestine. The purpose of an enteric coating is to delay therelease of the RMAAC until it reached the target site of action in thecolon. Thus, a useful enteric coating is one that remains undissociatedin the low pH environment of the stomach, but readily ionizes when thepH rises to about 6-6.5. The most effective enteric polymers arepolyacids having a pK_(a) of 3 to 5.

The most extensively use polymer is cellulose acetate phthalate which iscapable of functioning effectively as an enteric coating. However, a pHgreater than 6 usually is required for solubility and thus a delay indrug release may ensue. Another useful polymer is polyvinyl acetatephthalate (PVAP) which is less permeable to moisture and gastric fluid,more stable to hydrolysis and able to ionize at a lower pH, resulting inearlier release of actives in the duodenum.

A more recently available polymer is hydroxypropyl methylcellulosephthalate. This has similar stability to PVAP and dissociates in thesame pH range.

1. Polymethacrylate Coatings

A further example of currently used polymers are those based onmethacrylic acid, e.g., methacrylic acid ester copolymers with acidicionizable groups. Methacrylic ester monomers have the generic formulaCH₂ ═C(CH₃)COOR, wherein R is typically (C₁ -C₁₂)alkyl, and it is thenature of the R group that generally determines the properties of thecorresponding polymers. Methacrylates differ from acrylates in that thehydrogen of the acrylate is replaced by a methyl group or other alkylgroup. It is the a-methyl group of the polymethacrylate that imparts thestability, hardness, and stiffness to methacrylic polymers. Themethacrylate monomers are unusually versatile building blocks since theyare moderate-to-high boiling liquids that readily polymerize orcopolymerize with a variety of other monomers. All of the methacrylatesreadily copolymerize with each other and with the acrylate series; thusextreme ranges of properties can be built into the polymer. Furthermore,methacrylate polymers are generally non-toxic. A preferred methacrylatepolymer for use in the present invention is available from Rohm Tech,Inc., Malden, Pa. under the designation Eudragit® S-100.

Various systems are available that allow each of these enteric polymersto be applied as aqueous dispersions, thus facilitating the use ofaqueous film-coating technology for the enteric coating ofpharmaceutical dosage forms.

D. Process of manufacturing the unit dosage forms

The activated charcoal is employed as a carrier for the appropriateamount of radioisotope by addition of the radioisotope to the activatedcharcoal in normal saline followed by heating for about 0.1-1 hrs withstirring, and subsequent evaporation of the aqueous phase to dryness.For example, in example 1, hereinbelow, activated charcoal was mixedwith 8 mCi ^(99m) Tc-DTPA. Radioisotope dosages were selected to insureoptimal colonic imaging up to 32 hours after ingestion.

The charcoal may be mixed with the radioisotope prior to placing it inthe capsule and enterically coating the capsule, with a methacrylatesolution. Alternatively, the charcoal may first be placed in a gelatincapsule and the radioisotope subsequently injected into the capsule.Therefore, unit dosage forms comprising hard or soft gelatin capsulesthat are preferably enterically coated and which enclose an amount ofactivated charcoal effective to measure gut motility are also an aspectof the invention. Preliminary studies show that injection of theradionuclide does not result in early dissolution of the entericallycoated capsule in acidic environments. In this manner, the charcoal, canbe encapsulated in an enteric-coated capsule and later shipped from themanufacturing site and complexed with the radionuclide in a nuclearmedicine facility just before use.

A preselected diagnostic unit dose comprising one or more unit dosageforms is then administered to the test animal or human patient to attainthe desired in vivo levels. Doses useful for imaging can be empiricallyderived, from those found to be effective to image organs in healthyhuman subjects, such as those described hereinbelow, or from animalmodels. Typically, unit dosages are 0.001-100 g of radioactive activatedcharcoal, preferably unit dosages are about 0.01-20 g. Typical unitdosages of radiation ingested are about 1-40 mCi ^(99m) Tc, and about10-1000 μCi ¹¹¹ In, about 0.1-10 mCi ²⁰¹ Tl and about 0.1-20 mCi ⁶⁷ Ga.

The invention will be further described by reference to the followingdetailed examples.

EXAMPLE 1

Preparation of Radiolabeled Charcoal or Resin

Activated charcoal (100 mesh, 5 mg, J. T. Baker Chem. Co., Phillipsburg,N.J.) was mixed with 0.2-0.3 ml of the ^(99m) Tc-DTPA injection solutionprepared as disclosed hereinabove, comprising 8 mCi ^(99m) Tc-DTPA orthe 500 μCi of ¹¹¹ In-DTPA solution, for 15 minutes. The mixture wasevaporated to dryness at 90-100° C. ²⁰¹ TlCl and ⁶⁷ Ga-citrate werepurchased from Mallinckrodt Medical Inc., St. Louis, Mo. as injectablesolutions and absorbed onto charcoal by the same procedure.

Amberlitel® 120 P resin pellets (1.0 g) (Sigma Chemical Co., St. Louis,Mo.) were radiolabeled with 0.1-0.25 mCi InCl₃ in 0.4 N HCl as inprevious studies, the beads were rinsed with 0.04 N HCl twice and thendried. Camilleri et al., Am. J. Physiol., 257: G284 (1989). Amberlite®SRA-410 beads (1.0 g) were labeled in normal saline with 1 or 2 mCi:^(99m) Tc-DTPA for gastric or small bowel transit tests, respectively,and rinsed twice with normal saline and then with distilled water.Radioisotope dosages were selected to insure optimal colonic imaging upto 32 hours after ingestion.

The radiolabeled particles or dosage of charcoal were then placed into asize 1 hard gelatin capsule which was then coated with Eudragit® S-100,Rohm Tech Inc., Malden, Mass., which dissolves at alkaline pHs that areonly achieved in the distal ileum in humans. Fordtran et al., Am. J. DigDis., 11:503 (1966); Meltrum et al., Br. Med. J, 2:104 (1972); Evans etal., Gut, 29:1035 (1988).

The capsules were coated by preparing a coating solution of 13 g of theEudragit® S-100 in a stirred mixture of 31 ml acetone, 46 ml isopropylalcohol, 2 ml dibutyl phthate and 1.0 ml water, and dipping the filledcapsules into the solution twice.

EXAMPLE 2

In Vitro Studies

Samples of 5 mg activated charcoal comprising absorbed ^(99m) Tc-DTPA,¹¹¹ In-DTPA, ^(99m) Tc-pertechnetate (Per), ²⁰¹ Tl chloride, ⁶⁷ Gacitrate, and ¹¹¹ In chloride were incubated in a milieu that mimickedgastric content with 33 μM pepsin and 0.2 M hydrochloric acid (Thomfordeet al., J. Nucl. Med. Tech., 13:11 (1985)) at pH ranging between 2.0 and4.0, and in a separate milieu that mimicked small intestinal contentwith lipase and trypsin, each 2000 U/mL, and glycochenodeoxycholate, 1mM/L, at pH7. Thomforde et al., J. Nucl. Med. Tech., 13:11 (1985). Atspecified time points, the incubate was spun down, and the amounts ofradioisotope adsorbed to the solid charcoal particles and the amount offree radioisotope in the supernatant were determined.

Table I shows the results of association of radioisotopes to activatedcharcoal. Under all chemical conditions and, particularly, in a wide pHrange mimicking the intraluminal pHs in the gut, the radioisotopes wereefficiently and persistently adsorbed onto the activated charcoal.

                                      TABLE I                                     __________________________________________________________________________    ACTIVATED CHARCOAL STUDY WITH                                                 DIFFERENT RADIOPHARMACEUTICALS AT DIFFERENT TIMES (n = 3)                           Lipase + Trypsin + Glycochenodeoxycholic acid                           Incubation                                                                          pH = 7.2                                                                Time  .sup.99m Tc-Per                                                                     .sup.99m Tc-DTPA                                                                    .sup.111 InCl.sub.3                                                                 .sup.111 In-DTPA                                                                    .sup.201 TICl                                                                       .sup.67 Ga citrate                        __________________________________________________________________________     0 min                                                                              100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      50.0 ± 1.4                             90 min                                                                              100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      45.6 ± 2.1                              1 hr 100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      42.0 ± 1.8                              1 hr 30 min                                                                        100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      44.1 ± 2.3                              2 hr 100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      45.7 ± 5.0                              2 hr 30 min                                                                        100.0 ± 0.0                                                                      100.0 ± 0.0                                                                       99.6 ± 0.1                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      43.2 ± 1.1                              3 hr 100.0 ± 0.0                                                                      100.0 ± 0.0                                                                       99.9 ± 0.3                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      46.7 ± 2.3                             __________________________________________________________________________          Pepsin + HCl                                                            Incubation                                                                          pH = 2.4                                                                Time  .sup.99m Tc-Per                                                                     .sup.99m Tc-DTPA                                                                    .sup.111 InCl.sub.3                                                                 .sup.111 In-DTPA                                                                    .sup.201 TICl                                                                       .sup.67 Ga citrate                        __________________________________________________________________________     0 min                                                                              100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      58.9 ± 7.1                             90 min                                                                              100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      74.1 ± 1.4                              1 hr 100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      72.6 ± 1.2                              1 hr 30 min                                                                        100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      71.7 ± 0.8                              2 hr 100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      74.4 ± 0.8                              2 hr 30 min                                                                        100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      71.0 ± 1.8                              3 hr 100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      100.0 ± 0.0                                                                      68.2 ± 1.0                             __________________________________________________________________________

EXAMPLE 3

Performance of In Vivo Transit Studies

Ten healthy volunteers (5 men, 5 women) in the age range of 18 to 60years, who were not taking any medication on a chronic basis, wererecruited by public advertisement. All signed written informed consentof the research protocol which was approved by Mayo's InstitutionalReview Board and Radiation Control Committee. All volunteers werescreened for gastrointestinal symptoms by means of a validatedquestionnaire developed for identification of functionalgastrointestinal diseases. Talley et al., Ann. Intern. Med., 111:671(1989). All female participants had previously undergone sterilizationor had a negative pregnancy test within 48 hours of receiving theradiolabels.

Participants attended the General Clinical Research Center PhysiologyCore Laboratory at St. Marys Hospital after an overnight fast. A capsulecontaining a 10 mg dose of resin--¹¹¹ In or 2 mg of activatedcharcoal--^(99m) Tc was ingested at time 0, patients ate meals adlibitum and dual (anterior and posterior) gamma camera scans (GEStarcam, Milwaukee, Wis.) were obtained with the subject standing at 0,2, 4, 6, 8, 24, 28, and 32 hours after ingestion of the capsule.

All subjects completed the studies without complications. All scans wereobtained as planned except for two subjects (#9 and #10) who were unableto attend the laboratory for the final scan at 32 hours. FIG. 1 shows anexample of colonic silhouettes containing ^(99m) Tc charcoal and ¹¹¹ Inion exchange resin pellets. The distribution of radioisotope at 24 and32 hours is shown to be similar with the two radioisotopes. FIG. 2 showsa comparison of the time-activity curve for colonic radioactivity forthe two markers. The curves are virtually identical.

A region of interest program was used to estimate the amount ofradioactivity in the ascending, transverse, descending, sigmoid andrectum, and stool. These were designated as regions 1 to 5 respectivelyfor estimating the geometric center of counts for colonic transit, as inprevious studies. See, for example, Stivland et al., Gastroenterology,101:107 (1991); Proano et al., Am .J. Physiol., 258:G856 (1990);Camilleri et al., Gastroenterology, 103:3 (1992); Charles et al., MayoClin. Proc., 70:113 (1995) and Vassallo et al., Gastroenterology,102:102 (1992). The geometric mean of anterior and posterior counts wasestimated and, for each region, the proportion of radioisotope in theregion was estimated by dividing the counts in that region by the totalcounts of radioactivity in the entire colon. For ^(99m) Tc counts,crossover from the ¹¹¹ In window was first estimated and subtracted fromthe total counts using a downscatter factor of 0.8. A geometric center(weighted average of counts) was calculated as a summary of the transitprofile for each radioisotope at 4, 6, 8, 24, 28, and 32 hours.

In order to be deemed equally accurate and therefore applicableclinically, the radiolabeled activated charcoal profile would need tohave a transit profile that varied by less than 10% from radiolabeledion exchange resin pellets. A sample size of 10 provided >80% power todetect such an agreement between the two markers at α=0.05.

The data were first plotted as geometric center at each time point toassess intraindividual differences in transit profile using the twomarkers. Second, the differences in geometric center at each time pointwere plotted, and the 95% confidence intervals were plotted on eitherside of the median acta. If the confidence interval range did notoverlap with a difference in geometric center of zero, it would suggestthat the colonic transit profiles of the two markers were different.

FIG. 3 plots the difference in geometric center at the different timesof imaging. Note that the highest difference in geometric center unitsobserved was 0.1, which represents 10% or less of one of the colonicregions studied. FIG. 4 plots the 95% confidence limits above and belowthe median difference in geometric center at each scanning time. Theoverlap of each of 10 of the variances with the zero difference line,negates the null hypothesis that the transit profiles of the two markerswere significantly different.

This study shows that the transit profiles through the colon of ^(99m)Tc-RMACA and ¹¹¹ In ion exchange resin pellets in healthy adult humanparticipants were virtually indistinguishable. The normal profile ofactivated charcoal particles suggests that the adherence of the charcoalitself to intracolonic residue was greater than its adherence to thecolonic mucosa. This was an important consideration since the markermust reflect movement of intracolonic residue to be useful for measuringcolonic transit.

Activated charcoal is not ionically charged and, therefore, does notbind to ion exchange resin pellets in vitro. Therefore, the similarityof the transit profiles does not merely reflect binding of charcoal tothe pellets, but it likely reflects similar movement of both markers aspart of the intracolonic residue. Charcoal may also be advantageous overthe pellets since it binds to vegetable residue by virtue of its highadsorptive power and therefore actually traverses the colon withendogenous residues.

Another potential pitfall to be considered is that ^(99m) Tc might bebound to the ion exchange resin pellets. This is unlikely since the ionexchange resin pellets used were cation binders, whereas ^(99m) Tc waspart of an anion (pertechnetate). The in vitro studies suggest that thehigh adsorption and retention of radioisotope on the activated charcoalparticles insured that the radioisotope was retained in the charcoalthroughout its transit through the colon. Similarly, the excellentbinding characteristics of ¹¹¹ In to ion exchange pellets make it highlyunlikely that ¹¹¹ In dissociated from the ion exchange pellets andadsorbed onto the charcoal or to other particles in the colonic residue.

Activated charcoal binds medications and some nutrients, and this mightbe disadvantageous if the charcoal mixed with food constituents in thestomach or small bowel. However, since the charcoal carrier of theradioisotope is given in small quantities (5 mg or less), and thecharcoal is encapsulated throughout its passage through most of thesmall intestine by the enteric coated capsule, the likelihood of anydeleterious effect of the charcoal on nutrient or medication absorptionis negligible. Moreover, since the method is being developed as a test,it is unlikely that most patients would require more than occasionalingestion of the activated charcoal for measurement of colonic transit.

Since colonic transit profiles can be accurately assessed over a 24-hourperiod (Camilleri et al., Gastroenterology, 103:3 (1992)), the startingdose of ^(99m) Tc can probably be reduced to 4 or 5 mCi with adequatecounts for accurate measurements. At this dose, H_(E) is 360 mrad, andorgan exposures are summarized in Table II.

                  TABLE II                                                        ______________________________________                                        RADIATION EXPOSURE (mrad) WITH                                                4 mCi .sup.99m Tc-ACTIVATED CHARCOAL                                                                                     Go-                                Activity                                                                            Body   Stomach  SI   ULI  LLI  Marrow                                                                              nads H.sub.E                       ______________________________________                                        4 mCi 72     960      960  1840 1120 536   336  360                           ______________________________________                                    

All patents and publications are incorporated by reference herein, asthough individually incorporated by reference. While only certainpreferred embodiments of this invention have been shown and described byway of illustration, many modifications will occur to those skilled inthe art and it is, therefore, desired that it be understood that this isintended herein to cover all such modifications that fall within thespirit and scope of this invention.

What is claimed is:
 1. A method of measuring colonic motility, saidmethod comprising:(a) administering to a subject, a unit dosage formcomprising an effective amount of a radioisotope adsorbed on activatedcharcoal; and (b) employing scintigraphy to measure the colonic transitof said radioisotope.
 2. The method of claim 1 wherein the radioisotopeis selected from the group consisting of ^(99m) Tc, ¹¹¹ In, ²⁰¹ Tl, and⁶⁷ Ga.
 3. The method of claim 1 wherein the subject is a human.
 4. Themethod of claim 1 wherein the unit dosage form comprises about 0.01-20 gactivated charcoal.
 5. The method of claim 1 wherein the unit dosageform is enterically coated.
 6. The method of claim 1 wherein theradioisotope-bound activated charcoal is enterically coated.
 7. Themethod of claim 5 wherein the radioisotope-activated charcoal isenclosed in an enterically coated gelatin capsule.
 8. The method ofclaim 5 wherein the radioisotope-activated charcoal is formed into anenterically coated tablet.